1. Peptic ulcer Chen Jie Department of gastroenterology, The first affiliated hospital of Sun Yat-sen university

2. Ulcer Erosion Definition Chronic ulcer occur in stomach and duodenum (Pathologically, ulcer is a lesion extending deeper into submucosa)

4. Ideograph of gastric mucosa barrier PGE ( prostaglandin e) EGF( epidermal growth factor) Gastric acid and pepsin Pathogenesis CO 2 +H 2 O  HCO 3  HCO 3  HCO 3  HCO 3  pH 2 pH 3 pH 4 pH 5 pH 6 pH 7 H + H + H + H + Mucus Bicarbonate Epithelial cell Bllod flow Capillary Artery of submucosa Gastral cavity

5. Pathogenesis

6. Helicobacter pylori, Hp ( transmission electron microscope ) Hp is an important etiological factor of peptic ulcer

7. Evidences Detection rate of Hp in PU patients 1

8. Recurence rate of PU after successful eradication of Hp 2

9. Cyclo-oxygenase (COX) ( rate-limiting enzyme in PG synthesis) Arachidonic acid COX-1 Tissue type COX-2 Induced type NSAIDs Prostaglandin NSAIDs(non-steroidal anti-inflammatory drugs) is another important etiological factor of PU (-) (-) Prostaglandin Gastrointestinal tract Physiological function Inflammation Inflammatory reaction

14. Pictures of PU under endoscopy DU GU

15. X-ray barium meal examination --- Niche sign (direct sign of ulcer)

17. Steiner silver stain of gastric mucosa, showing abundantly microorganisms scattered within mucus (dark arrow indicated)

18. Culture Very small and translucent colony on the plate

19. Rapid Urease Test : urea in the reagent was broken down by Hp urease, then the PH value of the reagent changed, finally the yellow color of the reagent changed to read color

20. 13C Urea Breath Test (UBT)

22. ---larger size, dirty moss, swollen and stiff surrounding mucosa---cancer --- Definite diagnosis must depend on biopsy and pathohistological examination!! Gatric ulcer Gatric cancer Benign and malignant gastric ulcer

29. Proton pump inhibitor (PPI) Two antibiotics Colloidal Bismuth Subcitrate Amoxicillin , Clarithromycin , Tetracycline , Metronidazole , Furaltadone … + (1) Hp eradication regimen Or

37. What is the etiopathogenisis of PU?

42. Thank you!